APPLICATION FOR ADMISSION– INCOMING EXCHANGE STUDENT2018/2019

To be completed by the applicant: / Recent photograph
Family name:
First and middle names:
Nationality:
Home university:
Country:

FOR OFFICIAL USE ONLY

Student ID code / Study programme/school
Semester/year / Decision (POS/NEG)
Date of receipt / Signature Central International Office
Date of acceptance / Signature Departmental Coordinator
Erasmus+
Magellan Exchange
Free mover[1] / Accommodation
Yes
No / MVV needed[2]
Yes
No / Double degree students only
TOEFL/IELTS score:
NT2 (Dutch):

ONLY FULLY COMPLETED APPLICATION FORMS WILL BE ACCEPTED

PLEASE COMPLETE IN CAPITAL LETTERS

1. PERSONAL INFORMATION

Title: Mr Mrs Miss Ms

Family name/surname:

First and middle name(s):

Sex: Male Female

PERMANENT ADDRESS AND CONTACT DETAILS

Street and number:

Postal code: City: State: Country:

Tel. no: Cell phone: Fax:
(Country Code/Area Code/Telephone number)

E-mail:

Date of birth: /// Place of birth:

(Day/month/year) (City/country)

Nationality:

2. ADMISSION INFORMATION

Exchange programme
Double degree programme / 4. Study programme at Zuyd University of Applied Sciences
Please tick one of the boxes below:
1. Level of studies
Undergraduate
Postgraduate
2. Length of stay
Block 1 only (Sept-Nov)
First semester (Sept-Feb)
Block 3 only (Feb-Apr)
Second semester (Feb-July)
Academic year (Sept-July)
Other,
3. Accommodation
Yes
No / HotelManagementSchool (HHM)
Academy of Music (Conservatorium)
Academy of Fine Arts (ABKM)
Communication and Multimedia Design (C-MD)
Social Work
Creative Therapy
Occupational Therapy
Physiotherapy
Speech Therapy
Nursing
Other,

3. EDUCATIONAL BACKGROUND

DETAILS ON CURRENT EDUCATION

Name of university / Location
(City/country) / Date of entry
(Month/year) / Expected date of graduation
(Month/year) / Name of degree certificate / Please tick here if the programme is taught in English

PREVIOUS POST-SECONDARYSCHOOLS AND UNIVERSITIES

Name of school/university / Location
(City/country) / Date of entry
(Month/year) / Date of completion
(Month/year) / Name of diploma or certificate obtained / Please tick here if the programme was taught in English

SECONDARY SCHOOL / HIGH SCHOOL

Name of secondary/high school / Location
(City/country) / Date of entry
(Month/year) / Date of completion
(Month/year) / Name of diploma or certificate obtained / Please tick here if the programme was taught in English

4. LANGUAGE PROFICIENCY

Please complete this table using the following:

A: Native LanguageB: FluentC: Good Working KnowledgeD: ConversationalE: Non-existent

Language /
Level

English

Dutch

Have you completed one of the following language tests in the last 24 months? YesNo

If yes, attach a certified copy of yourresults

TOEFL (score: )IELTS (score: )

NT2 Dutch (score: )Other test: (score: )

5. INTERNATIONAL EXPERIENCE(if any)

Year / Length of stay / Country / Reason

6. SOURCE OF INFORMATION

Where did you hear about the programmes taught at Zuyd University of Applied Sciences?

Type of source / Please specify
Zuyd website
Advice from friend, student,relative
Advice from teacher at your university
Search engines (e.g. Google/Yahoo)
Other

7. MISCELLANEOUS

Please inform us about any special circumstances (e.g., physical disabilities, illnesses, whether you intend to bring other family members with you, etc).

8. DECLARATION

I am aware of the cost of participating in the programme of studies which I am applying for and I am able to meet all expenses involved (including possible fees for a visa and/or residence permit, insurance, room rent and living expenses). I certify that the information that I have provided in this application, and on all other application materials, is complete, accurate and true to the best of my knowledge. I understand that misrepresentation of any information may result in cancellation of the application or registration.I authorize Zuyd University of Applied Sciences to check the information provided by me and to forward my transcripts to the Registrar at my home university.

Date: Signature:......

9. HOMEUNIVERSITY INFORMATION (to be completed by the home university)

Name of home university contact:

(e.g. Study Abroad Coordinator, Coordinator International Relations, Head of Department, Programme Director, Academic Advisor, etc.)

Position:

University:

Address:

Postal code: City: Country:

Telephone no.: Fax: E-mail:

Date Signature:

Official university stamp:

10. EMERGENCY CONTACT

Name:

Relationship (e.g. partner, mother, father, brother, sister):

Address:

Postal code: City: Country:

Telephone no.: Cell phone no.:

E-mail:

APPLICATION PROCEDURE

Deadlines for application:

For admission in September 15 May, for admission in February 15 October

In order for your application to be processed rapidly, please send the completed application form

(all 6 pages) and all the otherdocuments to the following address (both by fax or e-mail and by regular post):

ZuydUniversity of Applied Sciences

Attn. Zuyd International Office

P.O. Box 634–6200 AP MAASTRICHT

THE NETHERLANDS

Before mailing your application, ensure that you have enclosed:
All programmes: / For official use only
fully completed application formsigned by:
- the applicant
- the home university coordinator
certified copies of all your academic transcripts with the official stamp of your school/university
copy of passport / identity card
copy of health insurance policy
2official passport photographs
a personal letter of motivation
a curriculum vitae (résumé)
double degree candidates only:
a copy of your OFFICIALTOEFL, IELTS or other score report
Non-EU students only: evidence of financial support (bank statement with contact details of the bank, bank statement of sponsor, etc.). See for details
ZUYD HOGESCHOOL – ZUYD UNIVERSITY OF APPLIED SCIENCES

Zuyd International Office

Brusselseweg 150, 6200 AP Maastricht, The Netherlands

Telephone: +31 (0)43 3466450/3466488

Website:

ZuydUniversityof Applied Sciences is committed to a policy of equal opportunity in

student admissions without regard to race, colour, religion, sex,

national origin, age, marital status or handicap.

Zuyd International OfficePage 1/6March 2017

[1]Please check with the study programme first

[2]Visa for a stay of over 90 days